Sunday, March 9, 2014

As the deadline approaches for most Americans to obtain health insurance, a flurry of changes by the Obama administration has led to a frenzied effort among employers, insurance companies, politicians and consumers to try and understand what they might mean.

The latest batch of adjustments came Wednesday, when the administration disclosed that it was delaying, once again, the deadline for people with old private health plans to buy beefed-up versions required under the health-care law. The cancellations of the old plans have been politically damaging for Democrats and the White House, because President Obama had vowed that the law would not prevent people from keeping insurance plans that they liked.

By allowing many people to keep their old plans for two years longer, the administration softened the blow for congressional Democrats up for reelection this fall. No longer do members have to fear a wave of cancellation letters right before the November midterm election.

But the changes have contributed to consumer confusion, as people try to sort through their options on the already hard-to-understand subject of health insurance, and race to meet a March 31 deadline to carry health coverage or face a fine. And the changes fuel suspicions that the law is deeply flawed, forcing the administration to try to patch it on the fly.

Republicans immediately leapt on the Wednesday announcement as a recognition that the law, as written, is unworkable.

"The administration has acted dozens of times over the last year to unilaterally delay or change the law because it was not ready for prime time," House Energy and Commerce Committee Chairman Fred Upton (R-Mich.) said in a statement shortly after the change was announced.

Since April 2010, there have been about two dozen legislative or administrative actions changing the Affordable Care Act, according to media reports and the Congressional Research Service.

The changes range from small clarifications to major shifts, like last year's delay of a major provision that requires employers with at least 50 workers to offer health coverage to full-time employees.

To add to the confusion, some modifications are changes to previous changes. For example, this is the second time that the administration has allowed some people to keep noncompliant plans longer than previously announced.

Many experts had predicted that the law would need to be tweaked. It is typical that large, complex pieces of legislation are adjusted and clarified during the implementation phase, as policies move from paper to the real world. Usually, Congress makes such technical corrections.

But, because the parties have been so polarized over the law, Congress has been unwilling to pass bills aimed at fixing the problems, with Republicans bent on repealing the law and Democrats fearful of reopening debate on such a divisive subject. As a result, the administration has made certain changes using the president's executive authority.

"I broadly view the administrative delays as a pragmatic realization that it is actually harder to do some of these things in reality than we thought when we put it down on paper," said Bob Kocher, a former Obama health-policy adviser.

Some of the adjustments came as a result of the rocky rollout of HealthCare.gov, the main federal portal for people in three dozen states to buy subsidized health insurance. For example, in December, the administration announced that there would be a "special enrollment period" to give people who ran into technical glitches on the Web site more time to sign up for coverage.

Meanwhile, people appear to be as confused as ever about the law. In a February poll taken by the nonpartisan Kaiser Family Foundation, about half of uninsured people said they do not have enough information to understand how the law will affect their families.

Some critics view the constant moving of the goal posts as a sign that the White House is not confident that consumers will ever warm to the health-care law.

"It sure looks like we're on a ramp to more changes, and those changes are occurring because people aren't buying it -- literally and figuratively," said Robert Laszewski, an insurance industry consultant who has been an outspoken critic of the administration's handling of the rollout.

Many supporters acknowledge that the law is playing out differently than envisioned when it was enacted, but they contend that it remains on track to accomplish its goal of curbing the rise in health-care costs, improving the quality of care and making insurance affordable for virtually everyone.

"It's just that it is accomplishing it much more slowly and painfully than anyone ever imagined," said Sara Rosenbaum, a health law professor at George Washington University and a supporter of the law.

State lawmakers have passed a new food safety law that they wish they hadn't.

Anyone working in a California restaurant or bar who prepares ready-to-eat food - from bagels to sushi to fruit salad to cocktails - has to wear gloves or use deli tissue, spatulas or tongs. But the new rule, which went into effect Jan. 1, has had so much blowback that lawmakers are already trying to repeal it.

"It had unintended consequences," said Assemblyman Richard Pan, D-Sacramento, a physician and chairman of the Assembly's Committee on Health, which carried the bill in the first place. "There was not a specific incident that led to the new rules. The statute was intended to make minor changes to the California Retail Food Code, because food safety is something we have to take very seriously. So we wanted to make sure that the bill was consistent with other food safety regulations, including minimizing bare-hand contact with food."

Ian Anderson pours drinks at 15 Romolo

Unfortunately, Pan said, the legislation failed to take into account that workers might have a good reason to touch food with their bare hands.

The "glove law" was supposed to be a consensus bill, Pan said. It was agreed upon that if aspects of the bill had opposition at any time in the process, those provisions would be removed from the proposal. But there was no resistance, and AB1252 sailed through both houses of the Legislature with unanimous approval in 2013 and was signed by the governor.

News to them

The problem was most small restaurant and bar owners didn't know anything about it.

"Literally not one person I know had heard about it," said Iso Rabins, founder of ForageSF, a local incubator for small food makers.

"The first time I heard about it was in January, when it had already passed," he said.

Rabins spearheaded a petition against the rules and has been instrumental in persuading legislators to try to cancel the legislation.

Food makers, restaurateurs and bartenders argue that the glove law is not only cost prohibitive, wasteful and counterproductive to environmental strides such as plastic bag bans, it is also not particularly valuable to public health.

Under the new provision, food and beverage handlers would have to change gloves every time they change tasks or touch another ready-to-eat food. Even then, they still would be required to wash their hands between glove changes. The concern is that amid multitasking, food and drink handlers might resist or forget to change gloves repeatedly.

Although the bill became law two months ago, restaurants and bars have until June to comply, but, by then, Pan hopes he will have rolled it back. The repeal attempt has been marked as emergency legislation, needs a two-thirds vote from the Assembly and state Senate, and must be signed by the governor. Pan doesn't expect it to be a problem.

If the law isn't rescinded, Remy Nelson, owner of Mojo Bicycle Cafe in San Francisco, estimates he'll go through 50,000 gloves a year just for bagels.

"It's not that we don't use gloves," he said. "But this means we have to change gloves for every food that's not going to be recooked. We're not Noah's Bagels. We do a really small number, and it takes 20 seconds to get the gloves on and off. People may not want McDonald's, but they want some speed. They have to get their food and get out the door."

Aaron Smith, executive director of the U.S. Bartenders' Guild and co-owner of 15 Romolo, a bar in North Beach, figures he'd lose $80,000 a year in revenue from the cost of gloves and inefficiency.

"The gloves would slow us down by about 8,000 drinks a year," he said. "We would have to accommodate more bartenders to make up the difference."

Bare hands needed

That doesn't take into account the dexterity that cooks and bartenders would lose for tasks such as preparing sushi or garnishing a drink with a lemon twist, which they say is nearly impossible when hands aren't bare. In fact, some sushi chefs have argued that part of the skill that goes into raw fish preparation is the temperature of one's hands. And then there's the concern of broken glass.

Under Russia's existing law, a neighbouring state would have to sign a treaty with Russia to allow part of its territory to become a new "subject" of the Russian Federation.

But Mikhail Yemelyanov, deputy leader of A Just Russia, said the law had been drafted for peaceful times, and did not go far enough for situations where a state was falling apart.

"In conditions where a neighbouring state is disintegrating I don't think the Russian Federation should be restricted in its ability to accept a territory whose people have expressed a clear will and desire to be in Russia," he said.

Since Russia's war with Georgia in 2008, the breakaway Georgian territories of Abkhazia and South Ossetia have come under Moscow's control.

Russia poured troops into both regions to help pro-Russian separatists who did not recognise Georgia's authority.

The other bill to be considered by the Duma -- Russia's lower house -- would speed up the procedures for issuing Russian passports.

Passport applicants would not have to pay a state tax, and previous residence in Russia would no longer be required.

In addition, they would not have to have sufficient funds to support themselves and would not have to give up their Ukrainian citizenship.

'Fascist threat'

The bill's preamble says it is aimed "at supporting the fraternal people of Ukraine, especially the Russian-speaking ones, who are defenceless in the face of the 'brown threat'," a reference to World War Two fascists who wore brown uniforms.

The bill would allow Ukrainians to apply for Russian passports at Russian diplomatic missions before 1 August, and they could become citizens after two months, instead of waiting a year, as is currently the norm.

The plan to have a new fast-track procedure for issuing Russian passports was announced in Sevastopol on Thursday by A Just Russia leader Sergei Mironov.

In the end, death came decisively. After days of feverish speculation, on February 26th Jan Brewer, Arizona's Republican governor, vetoed SB 1062, a bill passed by the legislature a week earlier that would have allowed private businesses to cite religious beliefs as a defence against lawsuits over discriminatory treatment. Although the law made no mention of sexuality it was widely, and correctly, interpreted as a licence for business owners or their employees to deny service to gays. Large corporations, local business groups and Republican bigwigs had fallen over themselves urging Ms Brewer to ditch the law. A group of Hispanic lawyers scrapped plans to hold a convention in Phoenix, the state capital; other boycotts, including of the Super Bowl in Glendale next year, might well have followed.

Another bad law avoided

To have signed the law would thus have amounted to a huge provocation. Still, Ms Brewer, who has not made courting minority groups a signature theme of her administration, was surprisingly full-throated in her rejection of SB 1062, saying it could have divided the state in ways that "we cannot even imagine". That seems right; the law's wording was worryingly vague.

But it is becoming hard to ignore the singular ability of Arizona's legislators to bring national scorn upon themselves by passing nasty, ill-considered legislation. The row over SB 1062 comes less than four years after the passage of SB 1070, a law Ms Brewer did sign that empowered state police to enforce federal immigration law and which, say critics, encouraged racial profiling. (The Supreme Court struck down most of its provisions before it went into effect.)

Other states are considering religious-freedom laws like Arizona's, and SB 1070 inspired similar legislation elsewhere. So why does Arizona take all the heat? Partly because it tends to go farthest; and also because it displays a peculiar inability to cope with the conundrums of modernity. Comparisons of SB 1062 to Jim Crow never seemed right, because Arizona differs from the conservative states of the south-east; it has a libertarian streak and is slowly turning leftwards, thanks in part to a growing Latino population. Gay-marriage proponents see it as a riper target than the states of the Confederacy. No other border state felt it necessary to pass SB 1070-style legislation. But Arizona's legislators ploughed on regardless. (The state legislature is one of America's most polarised.)

Yet as the gay-marriage juggernaut rolls on, the Arizona row does provide a useful reminder that social conservatism remains a potent political force. Most Americans back gay marriage, but most also say it violates their religious beliefs. The pace of such change is unprecedented; the absence of a backlash would be a surprise. The difficulty for conservatives is that their rational contentions -- that gay unions are bad for children, or the institution of marriage -- have, one by one, been weighed in courts and rejected. And so they have retreated to the realm of faith, where there is no obligation to provide argument, merely to demonstrate sincerity of belief.

The Arizona law, and similar bills elsewhere, appear to have been motivated by lawsuits against businesses that refused to provide services (photography, cakes) to gay couples on religious grounds. Federal law does provide for protection of religious sensibility, and states that allow gay weddings do not force places of worship to host them. It is not immediately obvious why such protections should not extend to the private sector; as defenders of Arizona's law argued, they do not shed their faith when they leave church on Sunday.

Still, that argument is probably better played out in the market than the courts. Hard cases, as the saying goes, make bad law. The irony is that none of these hard cases happened to take place in Arizona -- and the state still made a bad law.